Provider Demographics
NPI:1225021454
Name:COBBLE, ANITA DIANE (MD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:DIANE
Last Name:COBBLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N STATE OF FRANKLIN RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6971
Mailing Address - Country:US
Mailing Address - Phone:423-431-2477
Mailing Address - Fax:423-431-2478
Practice Address - Street 1:410 N STATE OF FRANKLIN RD
Practice Address - Street 2:SUITE 130
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6971
Practice Address - Country:US
Practice Address - Phone:423-431-2477
Practice Address - Fax:423-431-2478
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD30278208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6825938Medicaid
VA1225021454Medicaid
KS63032949Medicaid
NC8906200Medicaid
TN3709285Medicare UPIN
KS63032949Medicaid
VA1225021454Medicaid
TN103I020953Medicare PIN
TN103I020603Medicare PIN